Patient Acceptance Research Articles

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

IntroductionDepression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack...

Blood-based colorectal cancer (CRC) screening implementation into clinical practice in the outpatient clinical setting in the Appalachian highlands.

TPS10622 Background: Maximizing colorectal cancer (CRC) screening participation relies on tests that are acceptable, accessible, and patient-centered. While colonoscopy or stool-based tests have traditionally been the standard of care (SOC), they often present challenges related to timely completion and patient adherence. Blood-based tests (BBTs) detecting circulating tumor DNA (ctDNA) offer a quicker, less invasive alternative to previous methods of screening. While the BBTs exhibit comparable sensitivity and specificity to the existing noninvasive SOC, their user-friendly nature holds the potential to enhance adherence. This study aims to explore the implementation of a BBT and its impact on patient acceptability and adherence to CRC screening. The study focuses on the Appalachian population, known for higher CRC incidence1 and mortality rates2 compared to the general US population. Methods: The trial is being conducted at two primary care clinics. It consists of two phases over a 6-month period, aiming to enroll over 300 patients. Participants aged 45-84 years, identified as average risk for CRC according to USPSTF guidelines, and who have opted to be screened for CRC and are willing to participate in the study will be eligible. Exclusion criteria consist of higher-than-average risk for CRC according to the USPSTF standards. During Phase 1 (control period), patients meeting inclusion criteria will be offered SOC (colonoscopy and/or stool-based test) for 3 months followed by Phase 2 (intervention period) where a BBT in addition to SOC will be offered for another 3 months. Informed consent will be obtained prior to any study procedures. The BBT used for the study has a sensitivity of 83% and specificity of 90%. Patients who agree to BBT will undergo a single blood draw of 40 mL. Phase 1 has concluded with enrollment of 75 patients, while Phase 2 is currently ongoing and actively recruiting participants. Upon completion of study, an EMR review will be conducted on participants to evaluate screening rates before and after implementing the BBT and to assess adherence. The primary endpoint of the study involves calculating the total number of consented patients who opted for and completed either BBT or SOC during the interventional period compared to the total number of patients who opted for SOC during the control period. Final data analysis is expected by July 2024.

Comparison of Conventional and Digital Workflows in the Fabrication of Fixed Prostheses: A Systematic Review.

When considering dental restorations, the use of fixed partial dentures is one of the most widely accepted treatment options. In the past, fabrication was done using traditional techniques and the conventional workflow was by far the popular method; however, nowadays digital workflows are being used as a means to produce the prosthesis. This systematic review aims to compare the workflows by considering their respective qualities, such as precision, efficiency, cost-effectiveness, and clinical performance. A complete search has been carried out to incorporate any relevant studies published between the years2012 and 2023 indatabases such as Scopus, Web of Science, PubMed, ScienceDirect, and Cochrane Library. Two independent reviewers screened articles for inclusion and assessed the studies' methodological quality rating via the NIH Tool. A total of 22 relevant articles were reviewed after a systematic search strategy. The main outcomeof the review was digital workflows were found to reduce working time, eliminate the selection of trays, minimize material consumption, and enhance patient comfort and acceptance. The studies also showed that digital workflows resulted in greater patient satisfaction and higher success rates than conventional workflows. Workflows for digital dentistry demonstrated to be better than traditional ones due to the cost-effectiveness, accuracy, and time optimization for the fabrication of fixed prostheses.

PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform.

e23190 Background: It is well established that the monitoring and evaluation of PROs in cancer patients has a positive impact in both quality of life and overall survival [Basch E., JAMA 2017]. In parallel, the widespread use of electronic devices such as smart phones in the general population have increased significantly over recent years [Statista, 2023], representing a unique opportunity to operationalize ePROs. However, there is uncertainty about the feasibility and applicability of these technologies in certain patient population such as prostate cancer (PC) patients. PRO-WAVE1 aims to determine the acceptability and engagement of the Wave Health patient app and healthcare provider portal, enhanced for PC patients. Specific endpoints include measuring longitudinal use of varying ePROs to impact care management, patient health literacy, and ability to identify and manage emerging risks. Methods: Patients across eight sites in Spain engaged with the Wave Health App over a 13-week period. Each week, patients completed a validated weekly symptom review (WSR) assessing 16 Prostate cancer-specific symptoms, including severity and/or frequency of each; as well as a health-related QoL (FACT-P) and health literacy survey (CHLT-30-Dkspa). A report summary of the patients’ WSR was generated for care team view in the Wave Health Connect platform – specifically to conduct weekly check ins on patients, including verifying patient completion; evaluating report content; indicating plans for follow up per patient; and rating their perceived value of the platform. Results: 98 patients were enrolled in the study – of which 82 actively participated in the study (84% acceptance). The compliance rate for the ePRO questionnaires was 93.3%, while during their participation, patients used the app for an average of 12.2 weeks, and approximately two-thirds (67.4%) used the app for all 13 weeks. Patient satisfaction with the platform was 93%, with 100% of respondents feeling the information provided in the app was relevant to their personal experience. Correspondingly, almost all HCPs (98%) rated the platform as useful – with the majority willing to recommend it to their peers and future patients; 90% of HCPs positively perceived the platform’s impact on the quality of communication with patients. Conclusions: Study results exceeded expectations for patient acceptability and engagement with the app; as well as perceived usefulness of the portal among HCPs – suggesting the platform as an impactful tool for patients working with HCPs to manage treatment journeys. A larger study using a comparator arm will help further evaluate the impact on costs and clinical outcomes.

The social robot will see you now: patient acceptability of social robots in managing heart failure

The social robot will see you now: patient acceptability of social robots in managing heart failure

Implementation of a Pharmacist-Driven Aspirin Deprescribing Protocol Among Older Veterans in a Primary Care Setting.

Background Recent cardiovascular guideline updates recommend against the use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older people. However, aspirin use remains common in this population. Objective To implement and evaluate the benefit of a pharmacist-driven aspirin deprescribing protocol compared with primary care provider (PCP) education-only in a primary care setting. Methods This prospective, cohort project targeted deprescribing for patients prescribed aspirin for primary prevention of ASCVD. Patients were included if they received primary care services at the Milwaukee Veterans Health Administration Medical Center (VHA) and were 70 years of age or older. Criteria for exclusion were aspirin obtained outside the VHA system, aspirin prescribed for a non-ASCVD-related condition, and/or a history of ASCVD. Active deprescribing by pharmacists and PCP education took place in the intervention group with PCP education only in the standard-of-care group. The primary outcome was the proportion of patients who had aspirin deprescribed in each group. Secondary outcomes included patient acceptability of the intervention and barriers to implementation. Results A total of 520 patients were prescribed aspirin in the intervention group versus 417 in the education-only group. Sixty-five patients met intervention criteria and were contacted for aspirin deprescribing. The pharmacist-led active deprescribing group led to a higher rate of aspirin deprescriptions versus the education-only group (54% vs 18%; P = 0.0001) for patients who met criteria. Conclusion A pharmacist-led aspirin deprescribing protocol within a primary care setting significantly decreased the number of aspirin prescriptions compared with PCP education only.

Perspectives on technology: urethral slings in a post-mesh world.

To detail the history of synthetic mid-urethral slings (SMUSs) and fascial slings, their efficacy, associated complications, and changes to practice that have occurred after the issuing of the 2011 US Food and Drug Administration (FDA) Safety Communication statement on transvaginal mesh (TVM), and to highlight the need for surgical registries and high-quality randomised controlled data to guide recommendations for continence procedures, in view of current concerns regarding mesh. A literature search was conducted in EMBASE, PubMed, and the Cochrane Database of systematic reviews to identify articles published from 2011 onward, following the FDA Safety Communication regarding TVM. Prior to the formal FDA Safety Communication in 2011, TVM was considered a safe option for the treatment of both pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The 2011 FDA safety communications and ensuing widely publicised litigation against TVM manufacturers have shifted both surgeon and patient acceptance of mesh products. Several efforts by medical and government bodies have been made to establish ways to monitor the surgical outcomes and safety of mesh products. The Australasian Pelvic Floor Procedure Registry is one such example. Although SMUSs have a long and established safety profile, perceptions of mesh products for SUI have also been negatively affected. The extent of this, however, has yet to be adequately measured through qualitative and quantitative data. The available data suggest it has been difficult for patients and consumers to distinguish between TVM morbidity for POP vs SUI. Furthermore, there remains a lack of high-quality randomised or real-world registry data to definitively exclude the SMUS from the SUI treatment algorithm. Since SMUSs are a viable option for SUI treatment, the concept of a 'post-mesh world' remains contentious. Controversies surrounding SMUSs have changed the treatment landscape of SUI. Against the background of significant litigious action following the FDA warnings against mesh use, there has been significant reduction in the uptake of synthetic mesh products. Although there are ample data related to surgical outcomes and safety for both autologous fascial and retropubic SMUSs in carefully selected patients, informed consent and surgical training will be of paramount importance as newer synthetic materials reach clinical maturity.

A Cross-Sectional Study to Analyse Patients’ Decision-Making Variables for Prosthodontic Treatment

Objectives: The patient's attitude, appropriate treatment planning, and decision-making are necessary to fabricate dental prostheses. This study aimed to evaluate the factors influencing patients' decision-making, patient expectations, and approval of the suggested treatment strategy regarding prosthodontic treatment by the population in the Faridabad region. Methods: A cross-sectional survey was carried out amongst 143 patients in the Department of Prosthodontics at Manav Rachna Dental College, Faridabad, over one month to determine patient's attitudes toward treatment for dental prosthesis. The self-administered questionnaire was made in both English and Hindi languages. The questionnaire's Part A section included demographic data about patients enrolled in the epidemiological survey. Part B of the survey assessed their attitude toward the absence of teeth. Part C comprised close-ended multiple-choice questions assessing the factors affecting decision-making. Part D assessed the patient's expectations from the prosthodontic treatment. Part E evaluated whether the suggested course of treatment was accepted and the reason why the suggested treatment course was rejected. Statistical Analysis: Logistic regression analysis and cross-tabulation analysis were performed using the SPSS 23.0 program to assess the relation between the decision to choose dental prosthesis treatment and independent variables using Tukey's test. Findings: In this analysis, the p-values for age, marital status, gender, level of education, and socio-economic status, when associated with the acceptance of the treatment plan, were all above 0.05, suggesting no statistically significant correlation in these specific associations. However, the elderly population (>60 years) showed a higher percentage of acceptance. Also, female patients readily accepted the suggested treatment plan. Most patients demonstrated acceptance of the proposed course of treatment, with financial considerations emerging as a primary deterrent for those who declined. However, patients were hesitant to get treatment done if surgery was required. Novelty: This epidemiological survey highlighted the importance of the development of health policies regarding dental treatment to make it more affordable for all socioeconomic groups. Conclusion: The importance that patients have on appearance and the crucial role that dentists play in creating treatment plans. As a result, it draws attention to crucial areas that require improvement and intervention. Keywords: Decision making, Prosthodontics, Treatment protocol, Patient education, Patient acceptance of healthcare

The Roles of Non-Pharmacologic and Emerging Pharmacologic Management of Non-alcoholic Fatty Liver Disease and Sarcopenia: A Narrative Review.

Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent causes of chronic liver disease worldwide which is often seen in patients with metabolic abnormalities such as those with obesity and insulin resistance. On the other hand, sarcopenia is a generalized and progressive skeletal muscle disorder characterized by low muscle strength, low muscle quality, low physical performance, or a combination of the three. Both disease entities share several underlying risk factors and pathophysiologic mechanisms. These include: (1) cardiometabolic overlaps such as insulin resistance, chronic systemic inflammation, decreased vitamin D levels, sex hormone modifications; (2) muscle-related factors such as those mitigated by myostatin signaling, and myokines (i.e., irisin); and (3) liver-dysfunction related factors such as those associated with growth hormone/insulin-like growth factor 1 Axis, hepatokines (i.e., selenoprotein P and leukocyte cell-derived chemotaxin-2), fibroblast growth factors 21 and 19 (FGF21 and FGF19), and hyperammonemia. This narrative review will examine the pathophysiologic overlaps that can explain the links between NAFLD and sarcopenia. Furthermore, this review will explore the emerging roles of nonpharmacologic (e.g., weight reduction, diet, alcohol, and smoking cessation, and physical activity) and pharmacologic management (e.g., roles of β-hydroxy-β-methylbutyrate, branched-chain amino acid supplements, and testosterone therapy) to improve care, intervention sustainability, and acceptability for patients with sarcopenia-associated NAFLD.

Short- and long-term patient-reported outcomes of subcutaneous implantable cardioverter-defibrillator therapy

Abstract Background The safety and efficacy of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy are well-established. However, there is a paucity of patient-reported outcome data, despite the increasing emphasis on incorporating patients' perspectives into quality care assessments. Current guidelines also recommend evaluating psychological status and addressing distress in defibrillator patients. Purpose This study aims to assess perioperative and postoperative pain during S-ICD implantation, along with patient acceptance during follow-up. We also explore associations between these outcomes, clinical characteristics, and implantation variables. Methods A total of 149 consecutive patients (87% male, mean age 53±13 years, body mass index 27±4 Kg/m², ejection fraction 39±14%) who underwent S-ICD implantation across 11 centers were analyzed. Short-term endpoints included pain during and 6 hours after the procedure. Pain intensity was rated on a 10-point visual analogue scale. Long-term endpoint was S-ICD patient acceptance measured (on a 0-to-100 point scale) by the Florida Patients Acceptance Survey (FPAS) score and its components: Return to Function (RTF), Device-Related Distress (DRD), Positive Appraisal (PA), and Body Image Concerns (BIC). The survey was administered 12 months post-implantation. Results The S-ICD generator was positioned in an intermuscular pocket in 140 (94%) patients. Serratus anterior plane block (SAPB) was performed in 103 (69%) patients. 72 (48%) patients underwent the defibrillation testing. Implantation success was reported in all patients without operative complications. Overall, pain intensity during implantation was 2 [25th-75th percentile: 1-4], and 1 [1-2] for static pain and 2 [1-3] for dynamic pain, 6 hours post-procedure. SAPB was associated with significantly lower pain intensity during implantation (2 [1-3] vs. 4 [2-5], p<0.001) and non-significantly lower values of dynamic pain intensity 6 hours post-procedure (1 [1-2] versus 2 [1-3], p=0.076). The other tested variables, i.e. age, sex, body habitus, ejection fraction, omission of defibrillation testing, were not associated with different pain levels. S-ICD acceptance scores were favorable overall (total FPAS 77 [63-87], RTF 69 [56-88], DRD 25 [10-45], PA 88 [75-100], BIC 13 [0-38]). Patients who underwent SAPB exhibited better RTF (75 [56-88] versus 63 [50-69], p=0.002) and PA (88 [75-100] versus 75 [69-94], p=0.004). Conclusions S-ICD implantation resulted in minimal discomfort, especially with novel anesthetic techniques. Overall, patients reported good acceptance of the S-ICD. Improved acceptance was observed in patients who underwent SAPB, highlighting the significance of enhanced patient implantation experience for long-term outcomes.

Comparative evaluation of the efficacy of Triphala mouthwash and Curcumin mouthwash in the treatment of gingivitis – A randomized controlled study

BackgroundNumerous studies on Triphala and Curcumin mouthwashes were analyzed individually and no study has compared the efficacy of Triphala mouthwash to Curcumin mouthwash in the management of gingivitis. Although various mouthwashes have shown reduction of plaque and gingivitis the search is still on for an ideal mouthwash with minimum side effects and better patient acceptance. ObjectivesTo access the efficacy of all the mouthwashes in the management of gingivitis. MethodsBy purposive sampling, 81 patients of both sexes with gingivitis were randomized by lottery method into 3 groups - A, B and C. Group A received scaling and Triphala mouthwash, Group B received scaling and Curcumin mouthwash and Group C underwent scaling and received Chlorhexidine mouthwash. Oral hygiene was assessed using Plaque, Gingival and Bleeding indices at baseline,7th day and 14th day. The inter-group comparisons were analysed using One-way analysis of variance (ANOVA) and multiple comparisons using Tukey's Honest significant difference test (α = 0.05) and the intra-group comparisons for the indices across various time periods within each group were analysed using Repeated-measures ANOVA and Bonferroni-adjusted pairwise comparisons post hoc test (α = 0.05). The statistical significance was set at p ≤ 0.05. ResultsThe study has shown that herbal mouthwashes are as effective as chlorhexidine in treating gingivitis although curcumin mouthwash showed a greater potential in reducing gingival inflammation. ConclusionBoth Triphala and Curcumin mouthwashes were proven to be equally effective in reducing plaque, gingival and bleeding scores, although curcumin was better in reducing gingival inflammation. Hence herbal mouthwashes such as Triphala and Curcumin with no side effects can be considered as an alternative mouthwash to chlorhexidine.

Patient preference and acceptability of self-sampling for cervical screening in colposcopy clinic attenders: A cross-sectional semi-structured survey.

Low vaginal self-sampling has been pioneered as an important development to improve uptake of cervical screening globally. Limited research is available in specific patient groups in the UK exploring views around self-sampling to detect high-risk human papillomavirus (hrHPV) DNA. Therefore, we explored patient views to support development of a novel point-of-care self-sampling cervical cancer screening device, by undertaking a cross-sectional semi-structured questionnaire survey to explore preferences, acceptability, barriers and facilitators around self-sampling. Patients attending a colposcopy clinic, 25-64 years old, were invited to participate after having carried out a low vaginal self-sample using a regular flocked swab. Participants self-completed an anonymous 12-point questionnaire. Quantitative data were analysed in MS Excel and Graphpad Prism, and qualitative data with Nvivo. We recruited 274 patients with a questionnaire response rate of 76%. Acceptability of self-sampling was high (95%, n = 187/197; Cronbachs-α = 0.778). Participants were asked their choice of future screening method: a) low vaginal self-sampling, b) healthcare professional collected vaginal swab, c) cervical brush sample with healthcare professional speculum examination, or d) no preference. Preferences were: a) 37% (n = 74/198), b) 19% (n = 37/198); c) 9% (n = 17/198), and d) 35% (n = 70/198), showing no single option as a strong preference. Key motivators were: Test simplicity (90%, n = 170/190), speed (81%, n = 153/190) and less pain (65%, n = 123/190). Barriers included lack of confidence taking the sample (53%, n = 10/19), resulting in preference for a healthcare professional sample (47%, n = 9/19). Whilst self-sampling showed high acceptability, lack of strong preference for screening method may reflect that respondents attending colposcopy are already engaged with screening and have differing perception of cervical cancer risk. This group appear less likely to 'switch' to self-sampling, and it may be better targeted within primary and community care, focusing on under-screened populations. Any shift in this paradigm in the UK requires comprehensive education and support for patients and providers.

Penalty weight tuning in high dose rate brachytherapy using multi-objective Bayesian optimization

Objective. Treatment plan optimization in high dose rate brachytherapy often requires manual fine-tuning of penalty weights for each objective, which can be time-consuming and dependent on the planner's experience. To automate this process, this study used a multi-criteria approach called multi-objective Bayesian optimization with q-noisy expected hypervolume improvement as its acquisition function (MOBO-qNEHVI). Approach. The treatment plans of 13 prostate cancer patients were retrospectively imported to a research treatment planning system, RapidBrachyMTPS, where fast mixed integer optimization (FMIO) performs dwell time optimization given a set of penalty weights to deliver 15 Gy to the target volume. MOBO-qNEHVI was used to find patient-specific Pareto optimal penalty weight vectors that yield clinically acceptable dose volume histogram metrics. The relationship between the number of MOBO-qNEHVI iterations and the number of clinically acceptable plans per patient (acceptance rate) was investigated. The performance time was obtained for various parameter configurations. Main results. MOBO-qNEHVI found clinically acceptable treatment plans for all patients. With increasing the number of MOBO-qNEHVI iterations, the acceptance rate grew logarithmically while the performance time grew exponentially. Fixing the penalty weight of the tumour volume to maximum value, adding the target dose as a parameter, initiating MOBO-qNEHVI with 25 parallel sampling of FMIO, and running 6 MOBO-qNEHVI iterations found solutions that delivered 15 Gy to the hottest 95% of the clinical target volume while respecting the dose constraints to the organs at risk. The average acceptance rate for each patient was 89.74% ± 8.11%, and performance time was 66.6 ± 12.6 s. The initiation took 22.47 ± 7.57 s, and each iteration took 7.35 ± 2.45 s to find one Pareto solution.Significance. MOBO-qNEHVI combined with FMIO can automatically explore the trade-offs between treatment plan objectives in a patient specific manner within a minute. This approach can reduce the dependency of plan quality on planner’s experience and reduce dose to the organs at risk.

Comparative study of ambulatory versus inpatient laparoscopic cholecystectomy in Thailand: Assessing effectiveness and safety with a propensity score matched analysis.

Ambulatory laparoscopic cholecystectomy (LC) is increasingly recognized for its advantages over the inpatient approach, which advantages include cost-effectiveness and faster recovery. However, its acceptance is limited by patient concerns regarding safety, and the potential for postoperative complications. The study aims to compare the operative and postoperative outcomes of ambulatory LC versus inpatient LC, specifically addressing patient hesitations related to early discharge. In a retrospective analysis, patients who underwent LC were divided into ambulatory or inpatient groups based on American Society of Anesthesiologists (ASA) classification, age, and the availability of postoperative care. Propensity score matching was utilized to ensure comparability between the groups. Data collection focused on demographic information, perioperative data, and postoperative follow-up results to identify the safety of both approaches. The study included a cohort of 220 patients undergoing LC, of which 48 in each group matched post-propensity score matching. The matched analysis indicated that ambulatory LC patients seem to experience shorter operative times and reduced blood loss, but these differences were not statistically significant (35 minutes vs. 46 minutes, p-value = 0.18; and 8.5 mL vs. 23 mL, p-value = 0.14, respectively). There were no significant differences in complication rates or readmission frequencies, compared to the inpatient cohort. Ambulatory LC does not compromise safety or efficacy, compared to traditional inpatient procedures. The findings suggest that ambulatory LC could be more widely adopted, with appropriate patient education and selection criteria, to alleviate concerns and increase patient acceptance.

Vaccine Acceptance in Patients with Inflammatory Bowel Disease: Lessons Learned from the COVID-19 Pandemic.

Immunomodulating therapies, which are commonly used in patients with Crohn's disease (CD) and ulcerative colitis (UC), have been linked to an increased risk of contracting opportunistic infectious diseases, the majority of which are preventable through vaccination. Nonetheless, vaccination rates in these patients are suboptimal, and frequently lower than in the general population. The COVID-19 immunization schedule provided a new scenario for investigating vaccine acceptance in patients with inflammatory bowel disease (IBD), with uncertainty and concerns emerging and the number of subjects receiving the third and fourth doses of the vaccine gradually decreasing. This study investigated IBD patients' attitudes towards previous COVID-19 vaccine programs and identified the factors that influence their adherence. It considered demographic and disease-related factors as well as the role of gastroenterologists and primary care physicians (PCPs). Data were collected through a self-completed questionnaire administered to all adult IBD patients (age > 18) who visited the Gastroenterology, Hepatology, and Nutrition division at the University of L'Aquila (Italy) for a regular follow-up between November 2021 and December 2022. Non-IBD gastroenterological outpatients who visited during the same period were included as a control group. A total of 178 patients were included in the analysis. The IBD group consisted of 77 patients, 48.1% with CD and 51.9% with UC; the mean age was 49.5 years and 51.9% were female. Overall, 94.8% of IBD patients had undergone at least one vaccine dose and 79.2% had received two doses, versus 8% of the control group (p < 0.0001). A total of 84.4% of IBD patients reported their propensity towards COVID-19 vaccination, with an average agreement score significantly higher than the controls (p = 0.0044). The trust of IBD patients in the effectiveness of the COVID-19 vaccine (p < 0.0001) and its role in hastening pandemic resolution (p < 0.0001) is strongly related to motivation and propensity. Concerns about the safety of the COVID-19 vaccine in IBD (p = 0.0202) and fear of vaccine-induced flare-ups (p = 0.0192) were reported as the main barriers. No correlation was found between COVID-19 vaccine propensity and clinical features like the type of IBD, years of disease, activity, and ongoing treatment. Regarding the recommendations received from physicians to get vaccinated against COVID-19, IBD patients relied heavily on their gastroenterologists for advice, while the control group relied mainly on their PCPs. The overall positive attitude towards vaccinations reported in our study was better than that observed for other vaccines. The relationship of trust with the gastroenterologist should be used to boost vaccination against other preventable diseases in IBD patients. Our findings add information on the factors influencing vaccine propensity, which can be used to improve current vaccination strategies.

Implementation of lung ultrasonography by general practitioners for lower respiratory tract infections: a feasibility study

Objective To evaluate the feasibility of lung ultrasonography (LUS) performed by novice users’ general practitioners (GPs) in diagnosing lower respiratory tract infections (LRTIs) in primary health care settings. Design A prospective interventional multicenter study (December 2019–March 2020). Settings and subjects Patients aged >3 months, suspected of having LRTI consulting in three different general practices (GPs) (rural, semirural and urban) in France. Main outcome measures Feasibility of LUS by GPs was assessed by (1) the proportion of patients where LUS was not performed, (2) technical breakdowns, (3) interpretability of images by GPs, (4) examination duration and (5) patient perception and acceptability. Results A total of 151 patients were recruited, and GPs performed LUS for 111 (73.5%) patients (LUS group). In 99.1% (n = 110) of cases, GPs indicated that they were able to interpret images. The median [IQR] exam duration was 4 [3–5] minutes. LRTI was diagnosed in 70.3% and 60% of patients in the LUS and no-LUS groups, respectively (p = .43). After LUS, GPs changed their diagnosis from ‘other’ to ‘LRTI’ in six cases (+5.4%, p < .001), prescribed antibiotics for five patients (+4.5%, p = .164) and complementary chest imaging for 10 patients (+9%, p < .001). Patient stress was reported in 1.8% of cases, 81.7% of patients declared that they better understood the diagnosis, and 82% of patients thought that the GP diagnosis was more reliable after LUS. Conclusions LUS by GPs using handheld devices is a feasible diagnostic tool in primary health care for LRTI symptoms, demonstrating both effectiveness and positive patient reception. Trial Registration Number Clinicaltrial.gov: NCT04602234, 20/10/2020.

Tooth Discoloration from 2 Silver Fluorides Used in Adults with Special Needs: A Randomized Trial.

Discoloration of carious lesions after application of silver diamine fluoride lowers patient acceptance and limits its wider use for caries arrest. To assess lesion and tooth color changes from 2 novel silver fluoride (AgF) products and its relationship to caries activity (clinical visuo-tactile scores) and bacterial load (using laser fluorescence with the DIAGNOdent). A split-mouth design was followed, with matched smooth surface carious lesions in the same arch in adults with special needs randomized for 1-min treatments with AgF/potassium iodide (KI) (Riva Star Aqua, SDI) and AgF/stannous fluoride (SnF2) (Caries Status Disclosing Solution; Whiteley). Standardized images taken at baseline, immediately postoperatively, and at 3-mo review were subjected to digital image analysis to calculate delta-E and to track changes in luminosity of carious lesions. Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Significantly greater changes were seen in treated lesions than in the adjacent noncarious natural tooth structure, both immediately after treatment and at the 3-mo review (P < 0.0001). Color change and caries activity were not affected by tooth type, tooth location, plaque status, salivary status, or special needs condition. AgF/SnF2 caused transitory darkening immediately on application, while AgF/KI caused the immediate formation of yellow deposits (silver iodide). Both products caused significant darkening of treated lesions at 3 mo (P = 0.0009; P = 0.0361), with no differences between them (P = 0.506). Responding lesions showed larger and more perceptible color changes immediately after either AgF application (P = 0.002; P = 0.024). Both AgF products were highly effective for caries arrest in this patient population. Despite minor differences in the appearance of treated lesions at the time of application, both products lead to similar darkening of treated sites at 3 mo. This study shows the usefulness of silver fluoride used in conjunction with potassium iodide or stannous fluoride for achieving caries arrest in smooth surface lesions in adults with special needs. Patients need to be informed that long-term staining of the lesion occurs with both, similar to silver diamine fluoride.

Acceptance of virtual patients as a continuous professional development approach among practicing nurses in primary health care settings in a low-income country: a quasi-experimental posttest setup design

BackgroundVirtual patients are an educational technological approach used in healthcare education. Its distinctive features have rendered virtual patient technology appealing for the training of medical and healthcare students, particularly in the enhancement of clinical reasoning. Virtual patients are less often applied for continuous professional development for practicing healthcare providers, and there is a scarcity of studies exploring this possibility. This study aimed to assess the acceptability of nurses for using virtual patients as a continuous professional development approach.MethodThe study used a quasi-experimental posttest setup design. The study was conducted in ten primary healthcare settings in Rwanda. Among 76 nurses who consented to participate in the study, 56 completed the intervention and responded to the study questionnaire. Following a one-week program of continuous professional development on four non-communicable diseases, the study used a self-administered questionnaire based on the Technology Acceptance Model 3 to collect data. Descriptive analysis served as the primary method for analyzing participants’ responses. The study also used a correlation test to assess the relationship of variables.ResultsAcross all items in the questionnaire, the median response tended towards either agree or strongly agree, with only a minority number of participants expressing strong disagreement, disagreement, or neutrality. The results indicated a significant positive correlation between perceived usefulness and behavior intention (p < 0.001).ConclusionThe findings indicate an acceptability and behavioral intention of adopting virtual patients as an alternative continuous professional development approach among nurses working at health centers in Rwanda or other locations with similar contexts.

A survey on the knowledge and perception of orthodontic clear aligner systems among general dentists

To date, there is no information available on the general dentist’s experience with Clear Aligner case selection, type of clinical practice etc. Therefore, the purpose of this survey was to evaluate the knowledge of general dentists in their experience and types of dental malocclusion treated with CA, the patients demand and perception of CA treatment.A structured questionnaire was created to evaluate the knowledge and perception of clear aligner therapy among the general dentists. The study sample comprised of 196 licensed general dental practitioners who had more than 2 years of clinical experience post graduation. The structured questionnaire included 17 closed ended questions which sought to assess the knowledge and perception of Clear Aligner Therapy among the general dentists.There is a need for increased education and awareness among general dentists to enhance their knowledge and expertise in providing clear aligner treatment.: Overall, clear aligners have revolutionized orthodontic treatment by offering improved aesthetics, patient acceptance, and quality of life.

The impacto of mammaplasty and lipectomy on self concept and body self-perception image: integrative review

The impacto of mammaplasty and lipectomy on self concept and body self-perception image: integrative review